HomeMy WebLinkAbout12-18-78
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CO{;;/('NWi;.AL TH OF PENNSYLVANIA
~EPARTMENT OF REVENUE
Bur "J.U or- COUNTY COLLECTIONS I
___________J__
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*
.~fPLlCATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made lar c alsent to the transler 01 the lallawing securities al a Pennsylvania
Corparatian or a Natianal Banking Assaciatian located in Pennsylvania:
DATE 12/18/78
(a)_ 40 shares (b) Weis Markets Iu,,-_ ._~__~____.____(c) connnon
II~OTE: In describing securities enter in (a), ab Ole, either the number al shares 01 stack ar the lace amount al
r"gistered bonds, in (b), the name al the issuing company and in (c) the class 01 stock or the stated interest rate
end maturity date 01 registered bonds.)
j',SUED ON2/22/71,3/6/67 , and having a TOTAL MARKET VAtUE OF $
(Dote) h J H 'b' k
I h I h h Step en r1 1C
as 0 t e date 0 deat al t e decedent, _____________________
(Name of Decedent)
____________, on
1.080.00
2/23/78
who was late 01
St. Joseph's Parish Mechanicsburg
Cumberland
(Dote of death)
Penna
(Street and Number)
(Post Office) (County) (State)
Dr Marie Therese Burke & Father Stephen J Hribick Jt/ten
'j he securities are registered as lallows:
(Nome or names in which certificates are registered)
lU1:WfNIt~) Dr. Mar;e Ther.e.s~Burke .riQl Neb'tQwn_StregJ; Rd Newtown Square PA
p.;~~X) (Nome) (Add,.n)
SURVIVING TENANT NAME OF APPLlCANTX'-Marie Ther-"se Burke M.D.
COUNTY FILE NUMBERBJ~ 7 L::..l-~ ADDRESS OF APPLlCAN-r>Ol Newtown Street Rd
Newt?J7' Squar~
BUREAU FILE NUMBER__SIGNATURE OF APPLlCANr:~~; (Jbk.-L~~~.k...cC
"OTlCE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA c- DEPARTMENT OF REVENUE
CONSEN~_I()..IRAN1~ER~I:=_~URITIES DATE~'. ~, /1?r
I hereby consent to the transler 01 the above securities now registered in the name al the alaresaid
Decedent and waive the filing al a certilicate certifying to the payment 01 the transler inheritance tax to which
tho, property 01 said Decedent is made subject pursuant to the provisions 01 the Act 01 June 20, 1919, P.L. 521,
"s amended and the Act 01 June 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
01 the Act 01 April 9, 1929, P.L. 343.
This Consent ta Transler the herein described property operates anly in relerence to the estate 01 the
abave-named Decedent.
Si gned lor the Secretory 01 Revenue
B~~~. ~_ a~(lg~M, ~
,'o'::.r...$
::.: L:,I.;nl'
(Title) (County)
.
APPLlCA T ION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
-_I
'*'
C/)~')N1'lI!-""'L TH OF PENNSYL VANIA
r. 'PAR' MENT OF REVENUE
r'IJI ,. W OF COUNTY COLLECTIONS
":FPbICATJON (MUST BE FILED IN TRIPLICATE)
iC TliE PENNSYLVANIA DEPARTMENT OF REVENUE:
Applicalian is he'eby mode fa, c onsenl 10 Ihe tronsfe, of the following securities of 0 Pe'""ylvlln",
,. '.'o.')I'olion or 0 Notional Booking Associalion located in Pennsylvania:
~-DA TE __- l27T8~7_f:=.=_
225 shs (b)--.!'"nnsylv:lni" -"-o",~r_& Light_______n~ (c) common .______.~._
r :.IOlE: In describing securilies enler in (a), ab Ole, either Ihe number af shares of slack or Ihe face arr,o.I" 01
, <:islered bonds, in (b), Ihe name o.f Ihe issuing company and in (c) ,he closs of slack or th~ slaled intr."e:;1 ""e
"I moturily dole of regislered bonds.)
,'.::tIED ON 5/l/74.11/l903____, and having a TOTAL MARKET VALUE OF L_~034.27
(Date)
" Ilf the dole of dealh of Ihe decedenl, _Step~e~_J_ HJ:'ib~ck.______~_____, on 2/23/78
(Nome of Oecedt"nt)
(0",. of death)
1lC- was lale of
St. Joseph's Parish
-- .--.-------.- --.- ------_._-
Mechanicsburg
Cumberland
Penna
(SIr..t and Humber)
(Poat Office)
"., --_._-----._-------~--_._-~-
(County)
(Sto'.~
Dr Marie Therese Burke & Father Stephen J Hribick .It/ten
,he securilies ore regislered os fallows:_____.__ __ _____~.. . .____~ ..______..__~..____.~
(NClme or names in which certificates are reght.r.d)
l<P.111ml16e~) Dr.
,,:ixE6lkx~x )
SURVIVING TENANT
Matle.....:rher~.s..e.. .!lJu:ke 6QLN"w.town Stree.LRd.....Ne.wt,(llil) Sqllarp I'A..-.-.__..__.
(Hame) \./ (Address)
NAME OF APPLICANT "..~a":i"-~"_e':'.:~e_Burke~r:.:____._ _
UINTY FILE NUMBERdl::-:ZJ~:l!f",-~_ ADDRESS OF APPLICANT ~Ol_~.":,t~wn St~~d u__~____
@n~:q~/:l- .. ;& r
IHEAU FILE NUMBER_______ .._~SIGNATURE OF APPLlCANT._________ ~ __.".._.'.zy{AJ..
.I.TICE, IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
u_.__._____________ __n
COMMONWEAL TH OF PENNSYLVANIA ~ DEPARTMENT OF REVENUE
~QIiSENT TO TRANSFER SE~_UR1!lE2 DATE~_€'_J971
I hereby consent 10 Ihe tronsfer of the above securities now ,egislered in Ihe nome of Ihe aforesaid
--' -.- -----.--,.----..-
--------------.....--.----... -.
"cedenl and waive Ihe filing of 0 ce,tificale certifying to the paymenl of Ihe tronsfer inherilance lox 10 whid-,
,. property of said Decedenl is mode subjecl purs,,,. It 10 Ihe provisions of the Acl of June 20,1919, P.L. S:!1i,
, amended and Ihe Act of June 15, 1961, P.L. 373,05 omended. This is also in accordance wilh the provi..;.:;",.
f II,,, Acl of April 9, 1929, P.L. 343.
This Cansenlla Transfer the herei" describ.d p'ope't~ operote, only in reference 10 Ihe eSlate, of Ih"
,I ''''~-n'''ned Decedent.
~~~
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Signed for Ihe Secretory of Revenue
B~~J_L.
\rrA~f!;l"l' ~NDE1lSllI .
:-::,:':Tt:i~ OF WILJ..S
..-.........;;.'C.LCilill:l!I__________
(TIlle) (County)
.,.